New Procedures … But No Codes Some newer audiology diagnostic procedures have no associated billing code. Here are ways to increase your reimbursement chances. Bottom Line
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Bottom Line  |   June 01, 2015
New Procedures … But No Codes
Author Notes
  • Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. lsatterfield@asha.org
    Lisa Satterfield, MS, CCC-A, is ASHA director of health care regulatory advocacy. lsatterfield@asha.org×
  • Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org
    Neela Swanson is ASHA director of health care coding policy. nswanson@asha.org×
Article Information
Hearing Disorders / Practice Management / Bottom Line
Bottom Line   |   June 01, 2015
New Procedures … But No Codes
The ASHA Leader, June 2015, Vol. 20, 30-31. doi:10.1044/leader.BML.20062015.30
The ASHA Leader, June 2015, Vol. 20, 30-31. doi:10.1044/leader.BML.20062015.30
A patient complaining of dizziness needs a vestibular evoked myogenic potential (VEMP) evaluation—but there’s no corresponding CPT code (Current Procedural Terminology, © American Medical Association). So how do you bill Medicare?
Audiologists performing electrophysiology and vestibular tests have discovered that the process for developing reimbursement codes significantly lags behind technology. The delay is attributable to the need for FDA approval of devices, sufficient widespread use of the procedure, and the acculumation of substantial peer-reviewed literature that supports the use of the procedure.
But lack of a procedure code doesn’t automatically mean that the service is not a Medicare benefit. Audiologists performing newer procedures that are medically necessary diagnostic services for Medicare beneficiaries can bill for them and, with some additional documentation, may get paid.
Audiologists can use CPT 92700, unlisted otorhinolaryngologic service or procedure, when no other code describes the procedure performed. It is appropriate for:
  • VEMP evaluations for balance.

  • Saccadic testing.

  • Vestibular autorotation test (VAT).

  • Diagnostic analysis with programming of auditory osseointegrated devices.

Audiologists performing electrophysiology and vestibular tests have discovered that the process for developing reimbursement codes significantly lags behind technology.

Some caveats
Audiologists should not use 92700 for:
  • Procedures that don’t have their own codes but are captured in other codes. For example, threshold testing using auditory evoked potentials and auditory steady state response does not, at first glance, have a specific code. But CPT 92585 describes a “comprehensive” auditory evoked audiometry that does include those tests.

  • Neural response telemetry. The American Medical Association recommends using CPT 92584, electrocochleography.

  • Vestibular evaluation with goggles. CPT 92540 (basic vestibular evaluation) should be used regardless of recording mechanism (goggles or electrodes).

  • Analysis and programming of external bone conduction devices. Medicare classifies external devices as hearing aids, and hearing aid-related services are not a covered Medicare benefit. If the device has been surgically implanted in the skull bone, however, related services can be billed under 92700.

Documentation
Because 92700 represents a variety of unlisted procedures, claims for this code are reviewed manually for payment. The manual medical review process takes the claim out of the automated system and requires complete documentation. To receive reimbursement for 92700, the audiologist must provide documentation that:
  • Includes the patient’s report and results.

  • Includes the provider’s qualifications.

  • Describes in detail the service provided, including the effort required.

  • Describes the clinical use of and efficacy for the service.

  • Clarifies that the procedure is independent and not performed in conjunction with another billable procedure.

  • Records the time required to perform the procedure, including the delineation of prep time, evaluative time and post-evaluative counseling.

  • Describes the equipment used to perform the procedure, including any supplies.

  • Includes the usual and customary fee for the procedure from the practice/facility fee schedule.

Here are a few other suggestions to keep in mind when submitting CPT 92700:
  • Do not use any modifiers.

  • Do not report multiple units, even if two unlisted procedures are performed on the same day. Documentation should be clear about each independent procedure.

  • Submit the claim and the appropriate documentation each time you perform the unlisted service. A denial for one does not necessarily indicate you will be denied for the next patient.

Be diligent—and patient—when submitting 92700, and be prepared to defend the medical necessity of the services you provide.
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June 2015
Volume 20, Issue 6